Agenda item

The purpose of the report is to provide the Health and Wellbeing Board (HWB) with an update on the development of the Brent Health and Care Plan (the Brent Plan), with a specific focus on Older People’s services. It also makes reference to the sector level development for Older People Services through Delivery Area 3 of the North West London Sustainable Transformation Plan (NWL STP).

Helen Woodland (the Council’s Operational Director of Social Care) introduced the report which provided the Board with an update on the progress of delivery area three within Brent’s Health and Care Plan: Joining Up Older People’s Services.

The Board heard that this delivery area was focused particularly on bringing together existing services and identifying potential gaps on the frailty pathway. Helen Woodland stated that the aim was ultimately for a more coherent pathway across the different types of community and acute care settings. Members heard a brief overview of the achievements to date this year which included: the role of the Whole Systems Integrated Care model; the Integrated Reablement and Rehabilitation Service (IRRS); Effective Hospital Discharge and West London Alliance’s Integrated Discharge Initiative - as set out within the report. Helen Woodland outlined that the plans for the upcoming year would focus on community aspects such as joining up the Whole Systems Integrated Care and social prescribing project; expanding the remit of the Short-Term Assessment, Rehabilitation and Reablement Service (STARRS); and developing a more advanced model of care within care homes to continue to ensure that less people are admitted to hospital in the long term. 

James Walters (Divisional General Manager, London North West Healthcare NHS Trust) emphasised the importance of this work stream by outlining that approximately 50 per cent of the acute bed base at the London North West Healthcare NHS Trust was now occupied by those over 65 years old. He also mentioned that approximately 25 per cent of the bed base was occupied by those over 80 years old. He outlined that whilst ‘frailty’ services were not just centred on care of the elderly, the key element factor to be factored into service planning was the longer recovery time for elderly patients. He explained some of the key elements to STARRS model and its role in preventing unnecessary admissions to hospital by providing a rapid response service to patients both at home and Accident and Emergency (A and E). He also mentioned the emerging importance of Older Persons’ Assessment and Liaison (OPAL) teams in linking STARRS and specific rehabilitation and reablement services to reduce the length of stay in Acute Medical Units (AMU). He concluded that it was widely felt that care could be provided better by continuing to align services and bring health and social care elements closer together.

A Member of the Board asked for further detail on the savings identified from the Whole Systems Integrated Care initiative (within paragraph 4.5.1 of the report) and whether additional investment into this model of care, if possible, could generate even greater savings in future. Sarah Mansuralli (Chief Operating Officer, Brent CCG) confirmed that these were ‘real’ savings and that the STARRS model had been instrumental in this. She also outlined that the CCG had done work with GE Healthcare Finnamore which looked at the scope for greater care and care management services in the community. She said that the research had found that there remained a lot of patients that were not being reached that could benefit from this type of rapid response service. Discussions continued on the potential for investment in this type of scheme and the need to develop a collaborative ‘quid pro quo’ business case in cooperation with the different CCGs and Local Authorities in North West London to incentivise investment. It was felt that a unified approach across the NHS and social care was essential to make further progress with this type of integrated care model. It was agreed that a proposal for implementation and investment which took this into account would be brought to the next meeting of the Board.  

Questions also arose on whether examples of best practice were being tracked and whether there were innovative examples which could further improve service design. It was mentioned that the joint venture between Epsom and St Helier Hospital Trust and the Surrey Council was an interesting example to be assessed. James Walters responded that best practice examples were being monitored and that the evidence base for helping to shape frailty services continued to grow.   

RESOLVED that:

(i)         The progress of delivery area three of the Brent Health and Care Plan, Joining Up Older People’s Services, be noted; and

(ii)        A report which provided a proposal for implementation and investment on the frailty integrated service, as described in paragraph 4.5.1 of the report, be brought to the next meeting of the Health and Wellbeing Board.